Stoeter P, Ortega-Suhrkamp E, Voigt K
Fortschr Neurol Psychiatr Grenzgeb. 1975 Dec;43(12):631-47.
Although cerebral angiography should be approached with caution in the diagnosis of inflammatory cerebro-vascular disease there are some characteristic angiographic findings which may be helpful for classification and differential diagnosis. The proximal cerebral arteries are favourably affected by basal meningitis and thrombangiitis obliterans with resulting stenoses and occlusions. Whereas those inflammations originating from neighbouring skull structures mostly involve the intracavernous parts of the carotid artery, the tuberculous and mycotic arteritis prefer the supraclinoid carotid siphon. Peripheral vascular changes are found in luetic endangiitis, necrotizing and toxic angiitis and in collagenoses. Simultaneous involvement of the temporal arteries is of great diagnostic importance demonstrating the systemic character of the inflammatory process; in Horton's arteritis it can be a pathognomonic finding. Infectious endocarditis, some mycoses and malaria may lead to embolic occlusion of cerebral vessels. Mycotic aneurysms mostly have a broad base or a fusiform shape and do not prefer the localizations of congenital aneurysms. Angiographically, abscesses, tuberculomas and viral encephalitis may result in circumscribed hypervascularized areas. The characteristic angiographic findings are exemplified and discussed on the basis of 8 cases of inflammatory cerebro-vascular disease (tuberculosis, pneumococcal and unspecific bacterial meningitis, syphilis, mycosis, Takayasu-syndrome, panarteritis nodosa, temporal arteritis).
尽管在炎症性脑血管疾病的诊断中应谨慎使用脑血管造影术,但仍有一些特征性的血管造影表现可能有助于分类和鉴别诊断。基底脑膜炎和闭塞性血栓性血管炎对大脑近端动脉影响较大,可导致狭窄和闭塞。而那些源自邻近颅骨结构的炎症大多累及颈动脉海绵窦段,结核性和霉菌性动脉炎则好发于颈动脉鞍上虹吸段。在梅毒性血管内膜炎、坏死性和中毒性血管炎以及胶原病中可发现外周血管改变。颞动脉同时受累对诊断具有重要意义,表明炎症过程具有全身性;在 Horton 动脉炎中,这可能是一个具有诊断特征的表现。感染性心内膜炎、一些霉菌病和疟疾可能导致脑血管栓塞性闭塞。霉菌性动脉瘤大多具有宽基底或梭形,并不好发于先天性动脉瘤的好发部位。血管造影显示,脓肿、结核瘤和病毒性脑炎可能导致局限性血管增生区域。本文基于 8 例炎症性脑血管疾病(结核病、肺炎球菌性和非特异性细菌性脑膜炎、梅毒、霉菌病、高安综合征、结节性多动脉炎、颞动脉炎)举例并讨论了特征性血管造影表现。